深部经颅磁刺激联合药物治疗抑郁症患者焦虑抑郁情绪及社会功能的初步研究

Preliminary study on deep transcranial magnetic stimulation combined with drug therapy for anxiety,depression,and social function in patients with depressive disorder

目的探究深部经颅磁刺激(dTMS)联合药物治疗对抑郁症患者焦虑抑郁情绪及社会功能的影响。方法选取2022年9月—2023年12月河北医科大学第一医院精神卫生中心住院治疗的149例抑郁症患者为研究对象。采用随机数表法将患者分为dTMS联合药物治疗组(dTMS联合组,n=70)和单纯药物治疗组(单纯药物组,n=79)。单纯药物组采用单一的抗抑郁剂治疗,dTMS联合组在单纯药物组的基础上联合dTMS治疗,每周5次,共治疗2周。分别在治疗前及治疗第2周末,采用17项汉密尔顿抑郁量表(HAMD-17)及汉密尔顿焦虑量表(HAMA)评估两组受试者的抑郁及焦虑症状,采用功能大体评定量表(GAF)评估受试者的社会功能。采用独立样本t检验、χ^(2)检验等统计学方法比较两组间的疗效差异。结果单纯药物组和dTMS联合组各自治疗前后的HAMA[(26.10±8.60)分比(12.87±4.54)分;(26.89±6.98)分比(12.34±4.91)分]、HAMD-17[(26.43±6.40)分比(11.46±4.58)分;(26.83±4.62)分比(9.30±5.33)分]和GAF[(41.00±9.30)分比(52.36±11.31)分;(42.23±11.49)分比(58.54±15.31)分]评分比较,差异均有统计学意义(t=13.95、17.29、19.15、21.77、-11.95、-12.26,均P<0.05)。治疗2周后,单纯药物组与dTMS联合组的HAMA评分减分率[(0.46±0.27)比(0.53±0.19)]比较,差异无统计学意义(t=-1.73,P=0.09);HAMD-17评分减分率[(0.55±0.19)比(0.64±0.20)]比较,差异有统计学意义(t=-2.90,P<0.05)。dTMS联合组的GAF评分加分率高于单纯药物组[(0.46±0.25)比(0.30±0.23)],差异有统计学意义(t=-2.81,P<0.05)。结论dTMS联合药物治疗能快速改善抑郁症患者的焦虑抑郁情绪,且能促进抑郁症患者的社会功能改善。

Objective To explore the effects of deep transcranial magnetic stimulation(dTMS)combined with drug therapy on anxiety,depression,and social function in patients with depressive disorder.Methods From September 2022 to December 2023,149 patients with depressive disorder at the Mental Health Center of the First Hospital of Hebei Medical University were selected as participants.The patients were randomly divided into dTMS combined with drug therapy group(n=70)and drug therapy group(n=79)using a random number table method.Drug therapy group was treated with a single antidepressant,while dTMS combined drug therapy group was treated with dTMS in addition to the drug therapy,five times a week for a total of two weeks.Before treatment and two weeks after treatment,the 17 item Hamilton Depression Scale(HAMD-17)and Hamilton Anxiety Scale(HAMA)were used to evaluate the depression and anxiety symptoms of the two groups of subjects,and the Global Assessment Functioning Scale(GAF)was used to evaluate the social function of the subjects.Statistical methods such as independent sample t-test and chi square test were used to compare the efficacy differences between the two groups.Results The differences in HAMA[(26.10±8.60)vs(12.87±4.54),(26.89±6.98)vs(12.34±4.91)],HAMD-17[(26.43±6.40)vs(11.46±4.58),(26.83±4.62)vs(9.30±5.33)],and GAF[(41.00±9.30)vs(52.36±11.31),(42.23±11.49)vs(58.54±15.31)]scores before and after treatment between drug therapy group and dTMS combined with drug therapy group were statistically significant(t=13.95,17.29,19.15,21.77,-11.95,-12.26;all P<0.05).After two weeks of treatment,there was no statistically significant difference in the HAMA score reduction rate[(0.46±0.27)vs(0.53±0.19)]between drug therapy group and dTMS combined with drug therapy group(t=-1.73,P=0.09).There was a statistically significant difference in the HAMD-17 score reduction rate[(0.55±0.19)vs(0.64±0.20)]between the two groups(t=-2.90,P<0.05).The scoring rate of the GAF scale in the dTMS combined with drug therapy group was higher than that in the drug group[(0.46±0.25)vs(0.30±0.23)],and the difference was statistically significant(t=-2.81,P<0.05).Conclusions DTMS combined with drug therapy can rapidly improve anxiety and depression in patients with depressive disorder,and promote the improvement of social function.